BOX 1.

Observation of community health workers’ conducting their daily work.

Scenario

The day started at the NGO base and I was assigned to accompany a pair of CHWs. We walked for about 20 minutes before reaching a newly formed support group in a more formal settlement. The group was organised and had a chairperson and a secretary who took minutes. The support group opened with a prayer and CHWs commenced with the support group activities. I was introduced to the members as a colleague visiting the club to see the work that CHWs do.

One of the CHWs started taking out the instruments that were going to be used to measure blood pressure, weight and blood glucose. There were about 15 members on this day and I watched them getting ready to be measured. The majority of the members were women and many of them were overweight. A bathroom scale was used to measure weights and an automated blood pressure monitoring machine was used to measure blood pressure.

One CHW conducted weight and blood pressure measurement, whilst the other was responsible for measuring blood glucose. The same cuff size was used on all members. The cuff could not fit one of the women's arms and it was put around the wrist and a measurement was recorded. All the measurements were recorded in a book. Members whose weights were above the scale's threshold could not be measured. One of the members had an elevated blood pressure reading and another one had an above–normal glucose reading. The client with an elevated blood pressure reading was instructed to relax whilst the one with a high blood glucose reading was given water; both clients sat for a about 30 minutes before a second reading was taken. The CHW then wrote a note in her booklet and told both clients that the supervisor, a nurse, would come to observe them the next day.

After measurements were completed an education session was delivered by one CHW who spoke about diabetes and hypertension. The lecture focused on explaining what the conditions are and how they can be prevented, and finished with a lecture on diet. This lecture took about 20 minutes.

Lastly an exercise session was conducted for about 15 minutes. All members of the group participated, including the male participant with elevated blood pressure. After the exercise session CHWs recorded dates for collecting medication from the clinic cards. Thereafter we left the support group.

We walked to another area and found that the support group we were visiting did not convene on that day, as there was a death in the area and all the members went to support the bereaved family. We then proceeded to several households where we delivered medication packets to clients. Once at the household the person who received the medication had to sign in the CHWs’ booklet. Once the CHWs were done we then proceeded to the office to deliver the equipment that was used. This is how the day ended.

NGO, non-governmental organisation; CHW, community health workers